A significant elevation in the hepatic transaminases may be seen with:
(1) systemic hypotension
(2) vascular damage, including ligation
(3) thrombosis
Prompt revascularization and restoration of blood flow may be able to prevent hepatic injury following vascular injury, ligation or thrombosis.
Parameters:
(1) serum level of ALT and AST
(2) trend in the serum levels (rising vs stable/declining)
(3) presence of an alternative explanation for the findings
If the postoperative transaminases are elevated, then monitor the transaminases every 6 hours until the levels stabilize.
Perform hepatic duplex scanning of the hepatic artery and portal vein if:
(1) The transaminases are >=500 but < 1,000 IU/L and the levels are rising.
(2) The transaminases are >= 1,000 IU/L.
Consider magnetic resonance angiography, angiography, high resolution CT or exploratory laparotomy if the serum transaminases are >= 2,000 IU/L
